SECTION Z: ASSESSMENT ADMINISTRATION. Z0100: Medicare Part A Billing. Item Rationale. Coding Instructions for Z0100A, Medicare Part A HIPPS Code

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1 SECTION Z: ASSESSMENT ADMINISTRATION Intent: The intent of the items in this section is to provide billing information and signatures of persons completing the assessment. Z0100: Medicare Part A Billing Used to capture the Resource Utilization Group (RUG) followed by Health Insurance Prospective Payment System (HIPPS) modifier based on type of assessment. Coding Instructions for Z0100A, Medicare Part A HIPPS Code Typically the software data entry product will calculate this value. The HIPPS code is a Skilled Nursing Facility (SNF) Part A billing code and is composed of a five-position code representing the RUG group code, plus a two-position assessment type indicator. For information on HIPPS, access: If the value for Z0100A is not automatically calculated by the software data entry product, enter the HIPPS code in the spaces provided (see Chapter 6 of this manual, Medicare Skilled Nursing Home Prospective Payment System, for a step-by-step worksheet for manually determining the RUG code and a table that defines the assessment type indicator). Note that the RUG included in this HIPPS code takes into account all MDS items used in the RUG logic and is the normal group since the classification considers the rehabilitation therapy received. This classification DEFINITION MEDICARE-COVERED STAY Skilled Nursing Facility stays billable to Medicare Part A. Does not include stays billable to Medicare Advantage HMO plans. DEFINITION HIPPS CODE Health Insurance Prospective Payment System code is comprised of the RUG category calculated by the assessment followed by an indicator of the type of assessment that was completed. uses all reported speech/language pathology and auditory services, occupational therapy, and physical therapy values in Item O0400 (Therapies). This HIPPS code is usually used for Medicare SNF Part A billing by the provider. Left-justify the 5-character HIPPS code. The extra two spaces are supplied for future use, if necessary. September 2010 Page Z-1

2 Z0100: Medicare Part A Billing (cont.) Coding Instructions for Z0100B, RUG Version Code Typically the software data entry product will calculate this value. If the value for Z0100B is not automatically calculated by the software data entry product, enter the RUG version code in the spaces provided. This is the version code appropriate to the RUG included in the Medicare Part A HIPPS code in Item Z0100A. With MDS 3.0 implementation on October 1, 2010, the initial Medicare RUG-IV Version Code is Coding Instructions for Z0100C, Is This a Medicare Short Stay Assessment? Code 0, No: if this is not a Medicare Short Stay Assessment. Code 1, Yes: if this is a Medicare Short Stay Assessment. Coding Tip The CMS standard RUG-IV grouper automatically determines whether or not this is a Medicare Short Stay Assessment. MDS software typically makes this determination automatically. If the value for Z0100C is not automatically calculated by the software data entry product, use the definition found in Chapter 6 to determine the correct response. DEFINITION MEDICARE SHORT STAY ASSESSMENT is a Start of Therapy Other Medicare Required Assessment (OMRA) and is used for a short Medicare Part A stay that was not long enough to allow a complete rehabilitation therapy regimen to be established. This type of assessment allows an alternative Medicare Short Stay assessment RUG rehabilitation therapy classification as described in Chapter 6, Medicare Skilled Nursing Home Prospective Payment System. Z0150: Medicare Part A Non-Therapy Billing Used to capture the Resource Utilization Group non-therapy (RUG) followed by Health Insurance Prospective Payment System (HIPPS) modifier based on type of assessment. The nontherapy RUG is the code obtained when all rehabilitation therapy is ignored and will be limited to the Extensive Services, Special Care High, Special Care Low, Clinically Complex, Behavior and Cognitive Performance, and the Physical Function codes. September 2010 Page Z-2

3 Z0150: Medicare Part A Non-Therapy Billing (cont.) Coding Instructions for Z0150A, Medicare Part A Non-therapy HIPPS Code Typically the software data entry product will calculate this value. The HIPPS code is a SNF Part A billing code and is comprised of a five-position code representing the RUG code, plus a two-position assessment type indicator. For information on HIPPS, access If the value for Z0150A is not automatically calculated by the software data entry product, enter the HIPPS code in the spaces provided (see Chapter 6 of this manual, Medicare Skilled Nursing Home Prospective Payment System, for a step-by-step worksheet for manually determining the RUG-IV group and a table that defines assessment type indicator). Note that the RUG included in this HIPPS code is the nontherapy group and classification ignores the rehabilitation therapy received. This classification ignores all reported speech/language pathology and auditory services, occupational therapy, and physical therapy values in Item O0400 (Therapies). In some instances, this non-therapy HIPPS code may be required for Medicare SNF Part A billing by the provider. Left-justify the 5-character HIPPS code. The extra two spaces are supplied for future use, if necessary. Coding Instructions for Z0150B, RUG Version Code Typically the software data entry product will calculate this value. If the value for Z0150B is not automatically calculated by the software data entry product, enter the RUG version code in the spaces provided. This is the version code appropriate to the RUG included in the Medicare Part A non-therapy HIPPS code in Item Z0150A. With MDS 3.0 implementation on October 1, 2010, the initial Medicare RUG-IV Version Code is Z0200: State Medicaid Billing (if required by the state) Used to capture the payment code in states that employ the MDS for Medicaid case-mix reimbursement. September 2010 Page Z-3

4 Z0200: State Medicaid Billing (cont.) Coding Instructions for Z0200A, RUG Case Mix Group If the state has selected a standard RUG model, this item will usually be populated automatically by the software data entry product. Otherwise, enter the case-mix code calculated based on the MDS assessment. Coding Instructions for Z0200B, RUG Version Code If the state has selected a standard RUG model, this item will usually be populated automatically by the software data entry product. Otherwise, enter the case mix version code in the spaces provided. This is the version code appropriate to the code in Item Z0200A. Z0250: Alternate State Medicaid Billing (if required by state) Used to capture an alternate payment group in states that employ the MDS for Medicaid case-mix reimbursement. States may want to capture a second payment group for Medicaid purposes to allow evaluation of the fiscal impact of changing to a new payment model or to allow blended payment between two models during a transition period. Coding Instructions for Z0250A, RUG Case Mix Group If the state has selected a standard RUG model, this item will usually be populated automatically by the software data entry product. Otherwise, enter the case-mix code calculated based on the MDS assessment. Coding Instructions for Z0250B, RUG Version Code If the state has selected a standard RUG model, this item will usually be populated automatically by the software data entry product. Otherwise, enter the case mix version code in the spaces provided. This is the version code appropriate to the code in Item Z0250A. September 2010 Page Z-4

5 Z0300: Insurance Billing Allows providers and vendors to capture case-mix codes required by other payers (e.g. private insurance or the Department of Veterans Affairs). Coding Instructions for Z0300A, RUG billing code If the other payer has selected a standard RUG model, this item may be populated automatically by the software data entry product. Otherwise, enter the billing code in the space provided. This code is for use by other payment systems such as private insurance or the Department of Veterans Affairs. Coding Instructions for Z0300B, RUG billing version If the other payor has selected a standard RUG model, this item may be populated automatically by the software data entry product. Otherwise, enter an appropriate billing version in the spaces provided. This is the billing version appropriate to the billing code in Item Z0300A. April 2012 Page Z-5

6 Z0400: Signatures of Persons Completing the Assessment or Entry/Death Reporting To obtain the signature of all persons who completed any part of the MDS. Legally, it is an attestation of accuracy with the primary responsibility for its accuracy with the person selecting the MDS item response. Each person completing a section or portion of a section of the MDS is required to sign the Attestation Statement. The importance of accurately completing and submitting the MDS cannot be overemphasized. The MDS is the basis for: the development of an individualized care plan; the Medicare Prospective Payment System Medicaid reimbursement programs quality monitoring activities, such as the quality measure reports the data-driven survey and certification process the quality measures used for public reporting research and policy development. October 2014 Page Z-6

7 Z0400: Signatures of Persons Completing the Assessment (cont.) Coding Instructions All staff who completed any part of the MDS must enter their signatures, titles, sections or portion(s) of section(s) they completed, and the date completed. If a staff member cannot sign Z0400 on the same day that he or she completed a section or portion of a section, when the staff member signs, use the date the item originally was completed. Read the Attestation Statement carefully. You are certifying that the information you entered on the MDS, to the best of your knowledge, most accurately reflects the resident s status. Penalties may be applied for submitting false information. Coding Tips and Special Populations Two or more staff members can complete items within the same section of the MDS. When filling in the information for Z0400, any staff member who has completed a subset of item within a section should identify which item(s) he/she completed within that section. Nursing homes may use electronic signatures for medical record documentation, including the MDS, when permitted to do so by state and local law and when authorized by the nursing home s policy. Nursing homes must have written policies in place that meet any and all state and federal privacy and security requirements to ensure proper security measures to protect the use of an electronic signature by anyone other than the person to whom the electronic signature belongs. Although the use of electronic signatures for the MDS does not require that the entire record be maintained electronically, most facilities have the option to maintain a resident s record by computer rather than hard copy. Whenever copies of the MDS are printed and dates are automatically encoded, be sure to note that it is a copy document and not the original. If an individual who completed a portion of the MDS is not available to sign it (e.g., in situations in which a staff member is no longer employed by the facility and left MDS sections completed but not signed for), there are portions of the MDS that may be verified with the medical record and/or resident/staff/family interview as appropriate. For these sections, the person signing the attestation must review the information to assure accuracy and sign for those portions on the date the review was conducted. For sections requiring resident interviews, the person signing the attestation for completion of that section should interview the resident to ensure the accuracy of information and sign on the date this verification occurred. October 2013 Page Z-7

8 Z0500: Signature of RN Assessment Coordinator Verifying Assessment Completion Federal regulation requires the RN assessment coordinator to sign and thereby certify that the assessment is complete. Steps for Assessment 1. Verify that all items on this assessment are complete. 2. Verify that Item Z0400 (Signature of Persons Completing the Assessment) contains attestation for all MDS sections. Coding Instructions For Z0500B, use the actual date that the MDS was completed, reviewed, and signed as complete by the RN assessment coordinator. This date will generally be later than the date(s) at Z0400, which documents when portions of the assessment information were completed by assessment team members. If for some reason the MDS cannot be signed by the RN assessment coordinator on the date it is completed, the RN assessment coordinator should use the actual date that it is signed. Coding Tips The RN assessment coordinator is not certifying the accuracy of portions of the assessment that were completed by other health professionals. Nursing homes may use electronic signatures for medical record documentation, including the MDS, when permitted to do so by state and local law and when authorized by the nursing home s policy. Nursing homes must have written policies in place that meet any and all state and federal privacy and security requirements to ensure proper security measures to protect the use of an electronic signature by anyone other than the person to whom the electronic signature belongs. Although the use of electronic signatures for the MDS does not require that the entire record be maintained electronically, most facilities have the option to maintain a resident s record by computer rather than hard copy. Whenever copies of the MDS are printed and dates are automatically encoded, be sure to note that it is a copy document and not the original. October 2014 Page Z-8